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The correct graft orientation during descemet membrane endothelial keratoplasty (DMEK) using the “bubble-tap” technique

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Abstract

Purpose

To demonstrate a novel, alternative endothelium Descemet membrane layer (EDM) orientation method in Descemet membrane endothelial keratoplasty (DMEK) that does not involve prior ink or trepanation marking of the graft, or intraoperative ocular coherence tomography (OCT) guided graft implantation during surgery, thus preventing the occurrence of an upside-down graft implantation that leads with certainty to primary graft failure.

Methods

From 2017 to early 2020, 500 eyes underwent DMEK operation using the “bubble-tap” technique first described from Dr. Perdikakis in the department of ophthalmology of St.-Johannes- Hospital in Dortmund in Germany. Primary graft failure and re-bubbling results following “bubble-tap” assisted DMEK are presented.

Results

Primary graft failure due to upside-down graft implantation was not observed in any patient. Re-bubbling was performed in 4.8% of the eyes. In 1.8% of the cases, a re-DMEK was performed due to a graft failure.

Conclusion

The “bubble-tap” technique is a novel, reliable and easy to master orientation method of EDM that enables the surgeon to perform DMEK with safety even in complicated cases with poor visibility in the anterior chamber, while it yields superior or equal results in comparison to other graft marking methods or intraoperative OCT-guided graft implantation.

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Data availability

All data generated or analyzed during this study are included in this published article.

Abbreviations

AC:

Anterior chamber

BSS:

Balanced salt solution

BCVA:

Best-corrected visual acuity

DM:

Descemet membrane

DMEK:

Descemet membrane endothelial keratoplasty

DSAEK:

Descemet stripping automated endothelial keratoplasty

EDM:

Endothelium Descemet membrane layer

GAT:

Goldmann applanation tonometry

IOL:

Intraocular lens

MIGS:

Microinvasive glaucoma surgery

OCT:

Ocular coherence tomography

PK:

Penetrating keratoplasty

SF6:

Sulfur hexafluoride

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Clinic of Ophthalmology, St. Johannes Hospital, Johannesstrasse 9-17, 44137, Dortmund, Germany

    Georgios Perdikakis, Sofia Fili & Markus Kohlhaas

  2. Clinic of Ophthalmology Pallas, Zurich, Switzerland

    Iraklis Vastardis

Authors
  1. Georgios Perdikakis
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  2. Sofia Fili
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  3. Iraklis Vastardis
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  4. Markus Kohlhaas
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GP, SF, IV and MK. The first draft of the manuscript was written by GP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Georgios Perdikakis.

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Conflict of interest

The authors declare that there is no conflict of interest. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership or other equity interests; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in this observatory study involving human participants were in accordance with the ethical standards of the institutional research committee of St.-Johannes-Hospital in Dortmund, Germany and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent for participation was obtained from all individual participants included in the study.

Consent to publish

Informed consent for publication was obtained from all individual participants included in the study.

Animal research

No research is performed on animals in this study.

Plant reproducibility

No research is performed on animals in this study.

Image manipulation

No image manipulation is performed in this study.

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Perdikakis, G., Fili, S., Vastardis, I. et al. The correct graft orientation during descemet membrane endothelial keratoplasty (DMEK) using the “bubble-tap” technique. Int Ophthalmol 41, 2329–2337 (2021). https://doi.org/10.1007/s10792-021-01786-1

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  • DOI: https://doi.org/10.1007/s10792-021-01786-1

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